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Health  Essentials  for  Rural 
School  Children 


Proposed  by 

The  Joint  Committee  on  Health  Problems  in 

Education  of  the  National  Council  of  the 

National  Education  Association 

and  of  the 

Council  on  Health  and  Public  Instruction  of  the 
American  Medical  Association 


Prepared  by 

DR.  THOMAS  D.  WOOD 

Chairman  of  the  Committee  on  Health  Problems  of  the  National  Council 

of  Education 

525  W.  120th  Street,  New  York  City 


The  Joint  Committee  on  Health  Problems  in  Education 

of  the 

National  Council 

of  the 

National  Education  Association 

and  of  the 

American  Medical  Association 


Committee  of  the  National  Council  of  the  National  Education 
Association  on  Health  Problems  in  Education 

Thomas  D.  Wood,  Chairman, 
Columbia  University,  525  West  120th  Street,  New  York  City. 

William    H.    Burnham, 
Clark    University,    Worcester,    Mass. 

P.   P.    Claxton,    U.    S.    Commissioner   of   Education, 
Washington,  D,   C. 

F.    B.    Dresslar, 
Peabody    College,    Nashville,    Tenn, 

Clark    W.    Hetherington, 
University   of   Wisconsin,    Madison,   Wis. 

David   Starr  Jordan, 
Leland   Stanford  Jr.   University,  Palo   Alto,   Cal. 

John  F.   Keating, 
Superintendent    Public    Schools,    Pueblo,    Colo. 

Charles  H.  Keyes, 
Skidmore   School   of   Arts,    Saratoga   Springs,   N.   Y. 

Jacob  A.   Shawan, 
Superintendent   of   Schools,   Columbus,   Ohio 

Albert  E.   Winship, 
New   England  Journal  of  Education,   Boston,   Mass. 

Committee   of    the   American   Medical   Association    on   Health   Problems 
in    Education 

R.   W.   CoRWiN,  Chairman, 
Minnequa    Hospital,    Pueblo,    Colo. 

John  M.   Dodson, 
.   Rush  Medical  College,  Chicago,  111. 

M.    J.    ROSENAU, 

Harvard    University,    Boston,    Mass. 


Press   of 

American   Medical   Association 

Five   Hundred  and  Thirty-Five  North   Dearborn    Street 

CHICAGO 


Introduction 

The  first  pamphlet  report  of  this  joint  Committee  is 
entitled  "Minimum  Health  Requirements  for  Rural 
Schools."  Seven  hundred  and  fifty  thousand  copies 
of  that  eight  page  report  have  been  printed, 
through  the  generosity  of  the  Elizabeth  McCormick 
Memorial  Fund  of  Chicago,  and  most  of  these  have 
been  distributed  throughout  the  country  by  the  United 
States  Bureau  of  Education.  A  moderate  number  of 
copies  of  that  report  are  still  available,  and  these  may 
be  obtained  from  the  United  States  Bureau  of  Educa- 
tion in  Washington  or  from  the  Chairman  of  the 
Committee. 

The  first  report  deals  mostly  with  the  health  prob- 
lems of  the  rural  school  —  the  sanitary  surroundings 
of  the  school  child  in  the  country.  Minimum  sanitary 
requirements  for  rural  schools  are  proposed  in  that 
report  for  the  purpose  of  helping  to  establish  a  stand- 
ard of  fundamental  health  essentials  in  the  rural  school 
and  its  material  equipment,  so  that  attainment  of  this 
minimum  standard  may  be  demanded  by  public  opinion 
and  by  educational  authorities  of  every  school  in  the 
country. 

Conformity  to  the  minimum  sanitary  requirements 
should  be  absolutely  necessary  to  the  pride  and  self 
respect  of  the  community ;  and  to  the  sanction  and 
approval  of  county,  state,  and  other  supervising  and 
interested  official  or  social  agencies. 

Neglect  of  anything  essential  for  health,  in  construc- 
tion, equipment  and  care  of  the  rural  school  plant  is 
at  least  an  educational  sin  of  omission  and  may  rea- 
sonably be  considered  a  social  and  civic  crime  or 
misdemeanor. 

The  country  school  should  be  as  sanitary  and  whole- 
some in  all  essential  particulars  as  the  best  home  in 
the  community.  Further,  it  should  be  pleasing  and 
attractive  in  appearance,  in  furnishings  and  in  sur- 
roundings, so  that  the  community  as  a  whole  may  be 
proud  of  it ;  so  that  the  pupils  and  teacher  may  take 
pleasure  in  attending  school  and  in  caring  for  and 
improving  it. 


PLAN     OF    THIS    REPORT 

The  purpose  of  this  second  pamphlet  is: 

(a)  To  state  the  heakh  conditions  of  rural  school- 
children at  the  present  time. 

(b)  To  propose  and  recommend  the  practical  mea- 
sures which  seem  necessar}'  and  possible  for  the  health 
care  of  children  in  country  schools. 

(c)  To  report  praiseworthy  efforts  which  are  now 
being  made  in  a  few  instances  to  provide  for  health 
care  of  rural  school  children,  and  which  may  result 
in  giving  to  rural  school  children  at  least  as  much 
health  care  as  is  provided  for  children  in  the  cities. 


Essentials  for  Health  of  Rural  School 
Children 

PRESENT     CONDITIONS 

More  than  half  (about  12,000,000,  or  three-fifths) 
of  the  school  children  in  the  United  States  are  attend- 
ing rural  schools.  Country  children  attending  rural 
schools  are,  on  the  average,  less  healthy  and  are  handi- 
capped by  more  physical  defects  than  the  children  of 
the  cities,  including  all  the  children  of  the  slums.  And 
this  is  true,  in  general,  of  all  parts  of  the  United  States. 

Table  I  (page  4)  is  made  up  from  the  official  sta- 
tistics of  school  children  gathered  from  many  parts  of 
the  country.  These  statistics  lack  uniformity;  they 
contain,  doubtless,  many  errors  ;  but  there  are  probably 
as  many  errors  in  the  statistics  of  the  city  school 
children  as  in  those  of  children  in  the  rural  schools. 

The  claim  that  the  health  of  the  people  in  the  coun- 
try is  not  so  good  as  the  health  of  those  living  in  cities 
finds  further  proof  by  comparison  of  the  death  rate  of 
rural  New  York  and  of  New  York  City.  Table  II 
(page  5)  illustrates  this  important  fact. 

For  the  last  five  years  the  death  rate  in  rural  New 
York  has  been  higher  than  the  death  rate  in  New  York 
City,  the  largest  city  in  the  world.  It  is  apparent  that 
within  the  last  ten  or  twenty  years  the  standards  of 
life  in  cities,  in  relation  to  health  at  least,  have  risen 
above  those  of  rural  communities. 

It  is  just  as  true,  however,  and  of  the  greatest  sig- 
nificance, that  most  of  our  best  human  material  for 
leadership  in  city  and  country  must  still  come  from  the 
farms.  For  the  most  part,  the  raw  material  to  supply 
the  needs  of  civilization,  including  the  best  human  sup- 
ply, must  continue  to  come  from  the  soil.  This  is  in 
accordance  with  a  great,  universal  law  of  life. 

If  rural  America  is  to  continue  to  be  a  satisfactory 
nursery  of  human  life  for  the  nation,  it  must  be  made 
healthful  and  attractive;  it  must  provide  conditions 
favorable  for  the  cultivation  of  the  best. 

The  improvement  of  human  health  and  welfare  in 
rural  America  is  a  problem  of  the  greatest  significance 
in  relation  to  our  national  welfare.  It  is  a  problem  affect- 


ing  national  safety,  national  prosperity,  national  per- 
petuity. It  is  a  problem  dealing  with  the  most  essential 
and  most  endangered  of  all  of  our  national  resources. 
No  factor  is  of  greater  fundamental  importance  for 
securing  national  preparedness  either  for  peace  or  for 
possible  war. 


PER  CENT  5 


20 


2.5 


30 


3S 


♦0 


4J5 


50 

I4a8 


^^^^^^^^^%%^^%=$^%^:^?t.-^  TEETH  DEFECTS 
WMZQM 


IZ.b 
13.4 


23.4 


TONSILS 

ADEN0ED5 

EYE    DEFECTS 
MALIVUTRITIOM. 


LgA        ENIiARGED 
Z.7  GLANDS 


EAR  DEFECTS 


4  2      BREATHING 
2  J  DEFECTS 


3  5  5PINALI 

CURVATURE 


City  and   Country 

Children   Compared 

Percentages   from 
All  Av^ila"ble 
Statistics.     * 


1.65 
15 

ANEMIA 

Country  ■■■§ 

17 
17 

UNCLEAN 

city         ^//^^^//,\ 

1.25 
.32 

LUNG   DEFECTS 

• 

.74 
.40 

HEART  DiaEASE 

.8 
.2 

.^MENTAL  PEFECTS 

TABLE 

I 

Health  defects  of 

school  children. 

The  most  vital  phase  of  this  problem  of  rural  health 
relates    to    the    health    and    welfare    of    the   children. 
~j  Country  children  deserve  at  least  as  much  health  and 

'      happiness  as  city  children. 

*  This   table  is  based   on   the   reports  of  over  a  half  million   children. 


Country  children  are  entitled  to  as  careful  cultiva- 
tion as  crops  and  live  stock. 

It  is  recognized  more  clearly  every  day  that  the  pub- 
lic school  is  the  strategic  agency  to  provide  for  the 
children  of  each  community  not  only  the  best  possible 
methods  of  general  education  but  also  the  best  available 
standards  for  care  of  health. 

In  our  cities,  parents  of  all  grades  of  prosperity 
appreciate  increasingly  the  advice  and  guidance  of  the 
schools  regarding  better  care  of  the  children's  health. 
It  is  evident  that  the  same  methods  will  not  apply  in 
country  and  city,  but  the  fundamental  needs  of  chil- 
dren in  country  and  city  are  much  the  same.     With 


1900)90/ 

/902  /905 

I904-  1905 

1906 

1907  1908  I909  1910  1911 

9/2 

/9/3 

1914 

,?( 

?n 

POI 

iQ 

■    * 

j9.a 

1! 
It 

\ 

IP 

18.5 

II 
1/ 
1/ 

\ 

/_S_3 

/sa. 

I8.Z 

17 

" 

179 

I'' 

/6 

/6.2 

/'^.9 

/T.9 

/5 

iss- 

v' 

y 

15.2 

/5J 

y 

^ 

IS.Z 

^ 

I5J__ 

155 

/-f 

\ 

/ 

14-.$ 

*♦. 

,/^5 

/4 

/^ 

13.9 

^^ 

■*.7 

TABLE     II. 

Comparative   death   rates,    urban   and   rural. 

=  =  =  =   New  York  City. 

' —  New   York   State,   outside  of   New  York   City. 


reference  to  the  common  problems  of  life  and  educa- 
tion the  schools  of  city  and  country  may  learn  many 
important  lessons  from  one  another.  Provisions  in 
schools  for  health  supervision  and  care  of  children  are 
still  comparatively  new  both  in  city  and  country.  About 
four  hundred  cities  in  the  United  States  now  have 
health  work  of  the  schools  developed  to  some  degree 
of  usefulness  and  efficiency.  The  health  work  in 
rural  schools  is  still  very  new,  and  just  enough  has 
been  done  in  a  few  states  and  in  comparatively  few 
rural  schools  to  demonstrate  how  important  and  how 
practical  are  these  forms  of  health  work. 


THE      CONTROL     OF     COMMUNICABLE     DISEASE 

DAILY    HEALTH    INSPECTION 

Thoughtful  care  and  sympathetic  cooperation  of 
J  home  and  school  are  needed  to  keep  the  school  from 
distributing  communicable  diseases  throughout  the 
community.  If  there  is  fairly  intelligent  cooperation 
of  parents,  teachers  and  health  officers  in  school  and 
community,  there  need  be  no  epidemics  in  schools. 
Conscience  as  well  as  intelligence  on  the  part  of  all 
concerned  is  requisite  for  the  suppression  of  con- 
tagious diseases. 

No  child  should  ever  knowingly  be  exposed  to  con- 
tagious disease.  The  older  the  child  is  before  being 
exposed  by  accident  to  contagious  disease  the  less  apt 
he  is  to  catch  it.  The  older  a  child  is  before  having  a 
contagious  disease  of  childhood,  the  less  severe,  on  the 
average,  is  it  likely  to  be.  The  early  detection  of  signs 
of  children's  diseases  and  the  early  exclusion  from 
school  of  children  showing  such  signs,  are  the  best 
means  of  minimizing  the  communication  of  disease  in 
schools  and  of  removing  the  possibility  that  the  school 
may  act  as  a  disease  center. 

INDICATIONS    OF    HEALTH    DISORDERS    IN    CHILDREN    FOR 

WHICH     PARENTS     SHOULD     KEEP     CHILDREN     AT 

HOME     AND     NOTIFY     THE     SCHOOL 

Nausea  or  vomiting. 

Chill,  convulsions  (fits). 

Dizziness,  faintness  or  unusual  pallor  (alarming 
paleness  of  the  face). 

Eruption  (rash)  of  any  kind. 

Fever. 
.  Running  nose. 

Red  or  running  eyes. 

Sore  or  inflamed  throat. 

Acutely  swollen  glands. 

Cough. 

Failure  to  eat  the  usual  breakfast. 

Any  distinct  or  disturbing  change  from  usual  appear- 
ance or  conduct  of  child. 

The  foregoing  signs  should  be  used  also  by  teachers 
as  a  basis  for  excluding  pupils  from  school  for  the 
day,  or  until  signs  have  disappeared,  or  until  the  proper 


health  officer  has  authorized  the  return  of  the  pupil  to 
school.  Children  may  be  taught  —  without  developing 
disturbing  fears,  or  attempts  to  deceive  —  to  notice  the 
above-mentioned  signs  in  themselves  or  in  their  com- 
panions, and  thus  may  help  to  protect  the  school  from 
contagious  disease. 

The  detection  of  these  first  signs  of  health  distur- 
bance at  home,  by  the  parent  or  the  child,  before  start- 
ing for  school,  is  of  especial  importance  in  the  country 
where  the  longer  trip  to  school  with  greater  physical 
exertion,  sometimes  in  bad  weather,  would  be  particu- 
larly injurious  to  a  child  at  the  beginning  of  an  illness. 

In  cases  of  contagious  disease  among  schoolchildren, 
the  length  of  time  of  exclusion  from  school  must  be 
determined  by  the  medical  or  school  authorities. 

HEALTH     EXAMINATIONS     TO     DETERMINE     GENERAL 

PHYSICAL     FITNESS     OF    THE     CHILD     AND     TO 

DISCOVER     PHYSICAL     DEFECTS 

Every  school  child  should  have  a  health  examination 
once  a  year.  More  frequent  examinations  should  be 
provided  for  individual  pupils  who  need  special  atten- 
tion. All  health  examinations  and  attention  in  rural 
and  in  city  schools  should  be  under  the  supervision  of 
regularly  appointed  school  physicians  thoroughly 
trained  for  their  work.  Every  state  should  have  a 
state  health  inspector  of  schools  who  should  give  spe- 
cial attention  to  the  health  work  of  the  rural  schools. 
The  routine  tests  of  vision  and  hearing  can  best  be 
made  by  the  teachers,  as  these  tests  involve  to  an 
unusual  extent  mental  and  educational  as  well  as 
health  factors,  and  require  the  knowledge  of  pupils, 
possessed  by  the  teacher,  as  well  as  simple  methods  of 
examination  which  all  capable  teachers  can  easily 
learn.  The  general  health  examinations  in  the  rural 
schools  can  often  be  done  most  advantageously  by  the 
school  nurse  with  the  help  of  the  teacher. 

There  should  be  for  every  child  a  health  as  well  as 
a  scholarship  record  which  accompanies  him  through 
his  public  school  career.  This  should  be  a  part  of  the 
recordof  the  school  which  the  child  is  attending.  The 
following  form  or  blank  has  been  tested  sufficiently 
in  rural  as  well  as  city  schools  to  prove  its  practical 
value. 


8 

HEALTH     RECORD 
Name Eorn  in on   (date) 

Nationality  of  Father.  . .  .    Mother.  . .  .    Xo.  in  family,  Adults.  .    Children.  . 
Number  of  birth.  . .    History  of  Measles.  . .    Scarlet  fever.  . .    Diphtheria.. 

Whooping  cough Pneumonia Grippe 

Date  of  first   examination in   school 

1  yr.  2  yr.   3  yr.   4  j-r.   5  yr.   6  yr.   7  yr.  8  yr. 


1.  Age    and    vear 

2.  Grade     .  . .' 

3.  Class     

4.  Revaccinations     

5.  Diseases   during   year...  . 

6.  Date    of    examinations.  .  . 

7.  Height    

8.  \yeight    

9.  Nutrition    

IJ.  Anemia     

11.  Enlarged    glands    

12.  Nervous    diseases    

13.  Cardiac    diseases    

14.  Pulmonary    diseases    .... 

15.  Skin   diseases    

16.  Orthopedic   defect    

17.  Defect   of   vision 

18.  Defect   of   hearing 

19.  Defect  of  nasal  breathing 

20.  Defect    of    palate 

21.  Defect    of    teeth 

22.  Hernia     

23.  Hypertrophied    tonsils... 

24.  Adenoids     

25.  Mentality     

26.  Conduct     

27.  EfIort_ 

28.  Proficiency     

29.  Treatment    necessary.... 


FINDING      AND      REPORTING      PHYSICAL      DEFECTS 

DIRECTIONS     TO     TEACHERS TEST 

OF    EYESIGHT 

The  eyes  of  children  who  wear  glasses  should  be 
tested  with  the  glasses,  and  if  found  normal  should  be 
so  recorded. 

Hang  the  Snellen^  test  letters  in  a  good  clear  light 
(side  light  preferred)  on  a  level  with  the  head,  and  so 
placed  that  the  child  does  not  face  a  strong  light. 
Place  the  child  20  feet  from  the  letters.  Cover  one  eye 
with  a  card  held  firmly  against  the  nose,  without  press- 
ing on  the  covered  eye,  and  have  him  read  aloud,  from 
left  to  right,  the  smallest  letters  he  can  see  on  the  card. 
Make  a  record  of  the  result. 

Children  who  have  not  learned  their  letters,  obvi- 
ously, cannot  be  given  this  eyesight  test  until  after 
they  have  learned  them.    Pupils  who  cannot  read  may, 

1.  Snellen  test  charts  may  be  obtained  from  the  State  Education 
Department,  or  from   educational  supplj'  houses. 


however,  be  tested  by  charts  with  pictures  of  familiar 
objects  designed  for  this  purpose. 

TO     RECORD     THE     ACUTENESS     OF     VISION 

There  is  a  number  over  each  line  of  the  test  letters 
which  shows  the  distance  in  feet  at  which  these  letters 
should  be  read  by  a  normal  eye.  From  top  to  bottom, 
the  lines  on  the  card  are  numbered  respectively  50,  40, 
30  and  20.  At  a  distance  of  20  feet,  the  average  nor- 
mal eye  should  read  the  letters  on  the  20-foot  line,  and 
if  this  is  done  correctly,  or  with  a  mistake  of  one  or 
two  letters,  the  vision  may  be  noted  as  ^%o  or  normal. 
In  this  fraction  the  numerator  is  the  distance  in  feet  at 
which  the  letters  are  read,  and  the  denominator  is  the 
number  over  the  smallest  line  of  letters  read.  If  the 
smallest  letters  which  can  be  read  are  on  the  30-foot 
line,  the  vision  will  be  noted  as  ^%q  ;  if  the  letters  on 
the  40-foot  line  are  the  smallest  that  can  be  read,  the 
record  will  be  ^%o.  If  the  letters  on  the  50-foot  line 
are  the  smallest  that  can  be  read,  the  record  will 
be  20/50. 

If  the  child  cannot  see  the  largest  letters  (those  on 
the  50-foot  line),  have  him  approach  slowly  until  the 
distance  is  found  from  which  they  can  be  seen.  If 
5  is  the  nearest  distance  from  which  the  50-foot  letters 
can  be  read,  the  record  will  be  %o  (Mo  o^  normal). 

Test  the  second  eye,  the  first  being  covered  with  the 
card,  and  note  the  result  as  before.  With  the  second 
eye,  have  the  child  read  the  letters  from  right  to  left, 
to  avoid  memorizing.  To  prevent  reading  from  mem- 
ory, a  hole  li/o  inches  square  may  be  cut  in  a  piece  of 
cardboard,  which  may  be  held  against  the  test  letters 
so  as  to  show  only  one  letter  at  a  time,  and  which  may 
be  moved  about  so  as  to  show  the  letters  in  irregular 
order.  A  mistake  of  two  letters  on  the  20  or  30-foot 
line  and  of  one  letter  on  the  40  or  50-foot  line  may  be 
allowed. 

Parents  should  be  notified  if  : 

(a)  Vision  in  either  eye  is  ^%q  or  less. 

(b)  Child   habitually  holds   head   too  near  book 

(less  than  12  inches). 

(c)  Child  frequently  complains  of  headache,  espe- 

cially in  the  latter  portion  of  school  hours. 

(d)  Either  eye  deviates  even  temporarily  from 

normal  position. 


10 


TEST     OF     HEARING 


If  it  is  possible,  one  person  should  make  the  exam- 
ination for  an  entire  school  in  order  to  insure  an  even 
method.  The  person  selected  should  be  one  possessed 
of  normal  hearing. 

The  examination  should  be  made  with  the  whispered 
voice;  the  child  should  repeat  what  he  hears,  and  the 
distance  at  which  words  can  be  heard  distinctly  should 
be  noted. 

The  two  ears  should  be  tested  separately. 

The  test  should  consist  of  numbers,  1  to  100,  and 
short  sentences.  To  avoid  imitation,  it  is  best  that  but 
one  pupil  at  a  time  be  allowed  in  the  room. 

For  very  young  children  a  fair  idea  of  the  hearing 
may  be  obtained  by  picking  out  the  backward  or 
inattentive  pupils  and  those  that  seem  to  watch  the 
teacher's  lips,  placing  them  with  their  backs  to  the 
examiner  and  asking  them  to  perform  some  unusual 
movement  of  the  hand  or  other  acts. 

REPORTING    DEFECTS 

Physical  defects  should  be  reported  to  the  homes, 
and  all  possible  efiforts  should  be  made  by  teachers, 
superintendents,  school  nurses  and  school  doctors  to 
persuade  the  parents  to  obtain  for  the  child  the  care 
necessary  for  correction  of  all  defects  that  it  is  possible 
to  remedy. 

Our  schools  are  spending  millions  in  educating,  or 
trying  to  educate,  the  children  who  are  kept  back  by 
ill  health,  when  the  expenditure  of  thousands  in  a  judi- 
cious health  program  would  produce  an  extraordinary 
saving  in  economy  and  efificiency.  A  dollar  spent  in  a 
wise,  constructive  effort  to  conserve  a  child's  health 
and  general  welfare  will  be  more  fruitful  for  the  child 
and  for  the  general  good  than  a  thousand  times  that 
sum  delayed  for  twenty  years.  The  principle  of  thrift 
in  education  finds  its  first  and  most  vital  application 
in  the  conservation  and  improvement  of  the  health  of 
the  children. 

PHYSICAL    DEFECTS 

Possible  injurious  effects  of  the  more  important 
physical  defects  of  children  may  be  classified  as 
follows : 


11 

I.  Defective  eyes  with  imperfect  vision. 

(a)  Headache,  commonly  through  forehead  or  back 

of  head  or  both. 

(b)  Blurring  of  sight;  but  in   farsightedness  with 

eye  strain,  vision  may  be  exceptionally  good, 
especially  for  distant  objects. 

(c)  Nausea  and  dizziness  ;  sometimes  disturbance  of 

digestion,  with  resulting  malnutrition. 

(d)  Nervous  exhaustion. 

(e)  Nervous  irritation  and  lack  of  nervous  control, 

shown  in  muscular  twitching  of  face,  arms 
and  legs. 

(f)  Mental   inability   to   grasp   an   idea  presented 

through  the  eyes. 

(g)  Retardation  in  school. 
(h)  In  rare  cases,  convulsions. 

Some  medical  authorities  have  attributed  epileptic 
and  epileptiform  seizures  to  abnormal  eyes. 

II.  Defective  ears. 

(a)  Catarrh  of  middle  ear  —  danger  of  mastoid  dis- 

ease. 

(b)  Deficient  hearing  —  pupil  often  dull,  careless, 

listless,  inattentive,  and  mentally  backward. 

(c)  Retardation  in  school. 

(d)  Pupils  are  often  considered  mentally  defective 

when  the  only  primary   defect  is   imperfect 
hearing. 

III.  Adenoids. 

(a)   Structural  effects : 

1.  High-arched  palate. 

2.  Narrowing  of  upper  jaw. 

3.  Deformity   of   chest,    resulting    from   ob- 

structed and  imperfect  breathing,  shown 
by  lateral  depression  of  front  of  chest 
and  prominent  sternum  (breast  bone). 

4.  Disturbed  development  of  teeth  and  vocal 

organs. 

5.  Large  tonsils  in  one  third  of  cases. 


12 

(b)  Functional  disturbances : 

1.  Mental. 

a.  Disturbance  in  function  of  brain  re- 

sulting in  aprosechia  nasalis,  that  is, 
difficulty  in  forming  an  idea  of  any- 
thing new  ;  stupidity ;  difficulty  in 
retaining  ideas ;  weakness  of  mem- 
ory ;  inability  to  turn  thought  on 
a  definite  subject ;  lack  of  power 
of  attention. 

b.  Irritability,  depression  and  often  dis- 

orderly conduct. 

2.  Deafness. 

3.  Defects  in  sense  of  smell  and  taste. 

4.  Defects  in  voice  (nasal  voice). 

5.  Chronic   rhino-pharyngeal  catarrh,   shown 

by  a  persistent  nasal  discharge.  This  is 
often  one  of  the  first  symptoms.  In  very 
young  children  it  is  manifested  by 
snuffles. 

6.  Obstruction   of   air  passages   resulting  in 

breathing  disturbances,  manifested  by 
open  mouth  and  great  restlessness  at 
night,  the  child  being  forced  to  assume 
various  attitudes,  such  as  sleeping  on 
face,  in  order  to  breathe  better. 

7.  Reflex. 

a.  Catarrhal  spasm  of  larynx,  or  croup. 

b.  Headache. 

c.  Intractable  cough  and  hoarseness. 

d.  Bronchial  asthma. 

e.  Enuresis  (incontinence  of  urine). 

(c)  General  effects : 

1.  Malnutrition  and  anemia. 

2.  Underdevelopment,   physical   and   mental. 

3.  Predisposition  to  otitis  media  (middle-ear 

disease),  laryngitis,  colds  of  a  remit- 
tent nature ;  increased  susceptibility  to 
disease  infections,  such  as  tuberculosis, 
diphtheria,  scarlet  fever,  etc. 


13 

(d)  Description  of  appearance  of  a  child  with 
marked  adenoid  enlargement  —  mouth  open ; 
dull,  sleepy,  with  inquiring  look ;  upper  lip 
short  and  thick ;  upper  jaw  narrow ;  nasal 
orifices  small  and  pinched,  the  face  full  under 
the  eyes ;  listless  and  indisposed  to  physical 
or  mental  exertion ;  stupid  and  backward ;  in 
school,  from  one  to  two  years  behind  the  nor- 
mal pupil  of  same  age ;  undersi-zed. 

IV.  Enlarged  and  diseased  tonsils. 

Enlarged  or  diseased  tonsils  produce  many  of  the 
unfavorable  results  attributed  to  adenoids.  The  two 
conditions  are  often  associated  and  it  is  difficult  to  dis- 
tinguish between  their  effects.  Enlarged  and  dis- 
eased tonsils  mcrease  susceptibility  to 

(a)  Tonsillitis. 

(b)  Quinsy. 

(c)  Diphtheria. 

(d)  Rheumatism. 

(e)  Tuberculosis. 

(f)  Pneumonia,  and  other  forms  of  infection. 
The  presence  of   enlarged  tonsils  and  adenoids  in 

school  children  should  be  known  and  when  any  distur- 
bances of  health  can  be  attributed  to  them  by  a  com- 
petent physician,  these  structures  should  be  removed. 
Their  absence  in  such  a  case  is  an  unqualified  advan- 
tage. 

V.  Defective  teeth. 

"If  I  were  asl«Kd  to  say  whether  more  physical 
deterioration  was  produced  by  alcohol  or  by  defec- 
tive teeth,  I  should  unhesitatingly  say,  defective  teeth. 
In  some  schools  as  many  as  98  per  cent,  of  pupils  have 
defective  teeth.  From  50  to  75  per  cent,  of  all  school- 
children in  this^country  need  at  this  moment  dental 
care."  ^ 

(a)  Direct  efifects : 

1.  Pain    of    excruciating    type    resulting    in 

great  loss  of  time  and  rest. 

2.  Foul  breath  with  unsightly  and  inflamed 

mouth. 

2.  Osier:   Lancet.  London.  Oct.   21.   1902. 


\ 


14 

3.  Improper  mastication  of  food. 

4.  Extension  or  decay  in  sound  teeth. 

5.  Decay    of    temporary    teeth    resulting    in 

unsound  and  carious  permanent  teeth. 

6.  Infection  of  glands. 

7.  Infection  of  maxillary  (jaw)  bone. 

8.  Earache     with     otitis-media     (middle-ear 

disease)  and  deafness. 

9.  Headache. 

11.  Disturbance  in  function  of  eye. 
11.  Frequent  digestive  disturbance. 
(b)    Indirect  effects : 

1.  Condition  of  poor  nutrition  and  less  resis- 

tance to  disease. 

2.  Formation  by  carious  teeth  of  an  almost 

perfect  culture  bed  for  growth  of  patho- 
genic bacteria.  This  condition  with 
lowered  resistance  leads  to  increased 
frequency  of  infection  with  pneumonia, 
diphtheria,  etc. 

3.  General    infections    dangerous    to    life    in 

some  cases. 

4.  Results  which  accompany  defective  hear- 

ing. 

5.  Lowering    of    vitality    and    temporary    or 

permanent  ill  health. 

VI.  The  condition  of  the  skin  is  an  important  indica- 
tion of  the  general  tone  and  health  condition  of  the 
body.  Persistent  eruptions  should  be  noted  and 
treated. 

VII.  Abnormal  condition  of  the  heart,  even  if  tempo- 
rary, may  disturb  health,  and  if  neglected  may  result 
in  permanent  weakness  of  the  heart  itself  or  of  the 
body  in  general.  The  condition  of  the  heart  is 
always  an  important  index  of  the  health  condition, 
and  is  often  a  valuable  guide  in  adjusting  the 
amount  of  sleep,  arrangement  of  school  program, 
and  selection  of  muscular  exercise  which  is  most 
suitable  for  the  pupil. 


15 

VIII.  The  lungs  are  important  as  a  frequent  location 
of  tuberculosis.  Lung  tuberculosis  is  more  frequent 
among  schoolchildren  than  has  commonly  been  sup- 
posed. In  pupils  who  are  underweight,  anemic, 
lacking  in  vitality,  even  if  not  coughing,  the  lungs 
should  be  carefully  watched. 

IX.  Deviations  of  spine,  roundness  of  shoulders  and 
stooping  postures  are  common  among  boys  and  girls, 
especially  between  the  ages  of  11  and  16.  Many 
children  outgrow  these  conditions  without  special 
attention,  but  these  asymmetries  should  be  inspected 
from  time  to  time  to  prevent,  as  far  as  possible, 
the  more  chronic  defects  in  posture,  and  the  occa- 
sional cases  of  genuine  scoliosis  (curvature  of  the 
spine)  which  begin  so  insidiously. 

X.  Abdominal  hernia  (rupture)  involves  serious  and 
often  dangerous  weakness  of  the  abdominal  walls. 
It  is  important  for  the  welfare  of  children,  in  the 
occasional  cases  which  exist,  that  the  condition 
should  be  detected  and  given  appropriate  treatment. 

CORRECTION     OF     DEFECTS 

The  problem  of  securing  satisfactory  means  for  the 
removal  of  physical  defects  in  rural  school  children  is 
especially  difficult,  as  hospitals,  clinics,  nurses,  den- 
tists and  surgeons  are  usually  so  far  distant. 

The  county  unit  of  organization  for  health,^  as  well 
as  other  rural  interests,  has  already  proved  successful 
and  promises  the  best  results. 

Every  county  should  have  one  full-time  health  offi- 
cer; one  or  more  school  or  district  nurses,  and  at 
least  one  community  health  center,  to  provide  satis- 
factory, self-supporting  health  (including  dental, 
medical,  and  surgical)  service  for  all  the  people, 
including  the  school  children.  The  fullest  possible  use 
should  be  made  of  all  available  means  and  agencies 
for  providing  the  health  attention  needed  by  the  chil- 
dren. In  several  cities,  clinics  for  examining  eyes  and 
fitting  glasses,  and  dental  clinics  have  been  installed 
and  operated  successfully  in  school  buildings.  The 
only  dental  clinic  in  the  United  States  planned  defi- 
nitely for  rural  school  children  is  located  in  a  high 
school  building  in  St.  Augustine,   St.  Johns  County, 

3.  Mason  County,  Kentucky,  has  a  very  efficient  county  health  organ- 
ization of  which  the  county  superintendent  of  schools  is  president. 


16 

Florida.  In  Alaska,  one-room  schools  are  sometimes 
used  for  medical  and  surgical  clinics,  not  only  for 
children  but  also  for  adults. 

CARE    OF    THE    TEETH 

The  examination,  dental  treatment  and  daily  care 
of  the  teeth  are  matters  of  the  greatest  importance 
for  rural  as  well  as  city  school  children.  All  decayed 
teeth,  whether  temporary  or  permanent,  should  be 
filled  or  otherwise  definitely  treated.  Malocclusion 
(ineffective  meeting)  of  the  teeth  should  be  remedied 
and  can  be  corrected  in  early  childhood. 

It  has  been  recently  demonstrated  that  (in  addition 
to  daily  brushing),  the  (prophylactic)  cleaning  of  the 
teeth  of  children  every  three  to  six  months  by  the  den- 
tist or  by  a  properly  trained  dental  hygienist  will 
prevent  most  of  the  decay  of  teeth  which  takes  place. 

It  may  be  predicted  with  entire  confidence  that  in 
the  near  future  adequate  dental  care  will  be  insured 
to  all  school  children  in  the  country  as  well  as  in  the 
cities.  No  item  in  all  the  wonderful  measures  for  the 
health  care  of  the  soldiers  in  the  trenches  of  Europe 
is  more  significant  than  the  treatment  of  the  teeth 
provided  by  the  automobile  dentist  offices  used  in 
France  and  other  countries.  Shall  not  our  children  in 
the  country  schools  —  future  citizens  and,  if  necessity 
requires,  defenders  of  our  own  republic  —  receive  as 
good  dental  care  as  soldiers  in  war? 

The  establishment  of  effective  habits  of  daily  brush- 
ing and  cleansing  of  the  teeth  is  one  of  the  most  essen- 
tial features  in  health  teaching  in  the  schools.  Every 
child  should  have  his  own  tooth-brush  which  is  kept 
in  a  clean  place  and  is  used  immediately  after  eating 
at  least  once,  or  better,  twice  a  day. 

For  cleaning  the  teeth,  a  good  tooth  brush  with 
bristles  that  do  not  easily  break  or  pull  out,  should  be 
used.  The  teeth  should  be  brushed,  not  only  up  and 
down  and  across,  but  also  by  a  rotary  or  cir- 
cular motion  from  the  gums  of  one  jaw  over  the  teeth 
to  the  gums  of  the  other,  and  so  round  and  round. 
In  addition  to  the  tooth  brush,  dental  floss  (waxed  silk 
thread)  should  be  used  every  day  or  two  to  remove 
the  decaying  food  from  between  the  teeth,  where 
decay  most  often  takes  place.    The  best  mouth  wash 


17 

is  tin::e  water,^  which  may  be  used  beneficially  once 
a  day  to  rinse  the  mouth. 

THE     SCHOOL     NURSE 

The  school  nurse  has  already  demonstrated  the 
extraordinary  value  of  her  services  in  the  health  work 
of  the  schools.  Statistics  prove  that  in  one  prominent 
phase  of  her  work  the  school  nurse  bridges  the  gap 
between  failure  and  success,  or  at  least  between 
inefficiency  and  efficiency  in  a  vital  part  of  the  health 
program.  Without  the  service  of  the  nurse,  only  from 
15  to  25  per  cent,  of  the  pupils  have  physical  defects 
corrected,  following  the  notice  and  recommendation 
sent  by  the  school  doctors  to  the  parents.  On  the 
other  hand,  with  the  aid  of  the  school  nurse,  from  75 
to  90  per  cent,  of  the  pupils  reported,  receive  remedial 
attention. 

In  the  cities  of  the  United  States  there  are  about 
750  nurses  giving  most  or  all  of  their  time  to  the  work 
of  the  schools.  On  the  other  hand,  there  are  today 
only  about  fifteen  to  twenty  nurses  in  rural  dis- 
tricts employed  primarily  for  health  work  in  the 
schools.  The  service  of  the  school  nurse  is,  however, 
even  more  important  in  rural  communities  because  of 
the  greater  lack,  or  greater  distance,  in  the  country  of 
physicians,  hospitals,  clinics,  and  social  agencies  which 
are  so  helpful  in  advancing  health  work  for  the 
children. 

The  duties  of  the  rural  school  nurse  include  promi- 
nently the  following: 

(a)  Assisting  in  the  health  examinations  of  pupils. 

(b)  Explaining  to   the   parents  the   importance  of 

defects  found  in  children  and  helping  in  the 
arrangements  for  the  medical,  surgical  or 
dental  treatment  required. 

(c)  Giving  emergency  treatment  in  health   distur- 

bances and  following  up  treatment,  under 
medical  direction,  for  various  conditions. 

(d)  Providing    an    important    part    of    the    health 

teaching  for  the  pupils  and  giving  in  homes 
visited,  suggestions  and  advice  afifecting  not 
only  the  hea'lth  interests  of  the  children,  but 
of  the  home. 

4.  To  make^  lime  water,  place  one  half  cup  full  of  finely  powdered 
unslaked  lime  in  a  onart  bottle.  Allow  to  stand  twenty-four  hours  and 
pour  off  the  clear  liquid  into  bottle  to  use  for  mouth  wash.  This 
powder   may    be    used    for    successive    solutions    until    entirely    dissolved. 


18 

In  many  a  community,  not  only  in  city  but  in  coun- 
try, the  tactful,  devoted  nurse  has  made  for  herself 
a  place  of  the  greatest  influence  in  promoting  health 
and  human  welfare  in  general. 

Ever}'  community  should  have  the  service  of  a  nurse 
whose  first,  if  not  sole,  duty  is  to  care  for  the  health 
of  the  school  children. 

WARM     LUNCHES    IN     SCHOOLS 

Every  growing  child  needs  a  warm,  nourishing  mid- 
day lunch.  One-quarter,  at  least,  of  all  school  children 
are  insufficiently  nourished.  Rural  school  children 
suffer  in  as  large  a  percentage  of  instances  from  defec- 
tive nutrition  as  do  the  school  children  in  the  cities. 

The  practice  of  providing  warm  school  lunches  in 
city  schools  is  increasing  very  rapidly  and  has  been 
so  successful  that  this  idea  is  extending  throughout  the 
countr}',  and  during  the  present  year  a  great  many  rural 
schools  in  several  states  have  adopted  the  plan  of  warm 
lunches  for  pupils. 

A  school  lunch  service  should  be  a  part  of  every 
rural  school.  It  should  be  fostered,  at  least,  if  not 
entirely  created,  owned  and  managed  by  the  school 
authorities.  It  can  be  most  successfully  managed 
cooperatively  by 

Ta)  The  school  authority  (district  or  county). 

(b)  The  teacher. 

(c)  Pupils. 

(d)  Parents  of  the  children. 

Every  school  building  should  have  a  simple  kitchen 
equipment  in  a  small  room  built  for  this  purpose,  or 
in  the  school  room.  A  simple  equipment,  not  including 
the  stove,  can  be  purchased  for  from  S4  to  SIO. 
Parents  can  club  together  and  furnish  either  a  fixed 
sum  of  money  or  supply  of  food  materials.  The 
teacher,  with  the  aid  of  pupils  working  in  groups 
periodically,  can  prepare  the  lunches.  This  is  now 
done  in  man}'  of  the  schools  having  lunch  service. 
The  preparation  of  the  school  lunch  makes  the  best 
possible  demonstration  for  a  lesson  in  domestic  science 
and  cooker}'.  The  children  with  the  warm  lunch  are 
better  nourished  and  do  their  school  work,  especially 
in  the  afternoon,  with  better  results.  The  instruction 
in  selection  and  preparation  of  foods  in  many  cases 
extends  through  the  pupils  to  the  homes,  and  this  is. 


19 

in  the  country  particularly,  the  most  effective  way  of 
influencing  beneficially  the  standards  and  methods  of 
the  homes. 

SANITARY    AND     ATTRACTIVE     RURAL     SCHOOLS 

The  health  of  children  is  affected  vitally  by  their 
surroundings. 

The  buildings,  which  house  under  compulsion  three- 
fifths  of  the  nation's  children  of  school  age  for  eight 
hundred  hours  each  year,  should  be  beyond  all  possi- 
bility of  failure,  free  from  unhealthful  and  unfav- 
orable features. 

The  rural  school  is  relatively  the  worst  type  of 
building  in  the  country.  It  should  be,  in  essential  fit- 
ness for  its  purposes,  the  very  best. 

EFFICIENT    TEACHERS     FOR     HEALTH     WORK 

The  teacher  in  the  rural  school  has  inevitably  a 
larger  opportunity  and  responsibility  for  all  educa- 
tional functions  than  does  the  city  teacher.  This  is 
especially  true  in  matters  relating  to  the  health  and 
welfare  of  the  pupils.  She  is  further  .away  from  the 
help  and  services  of  superintendent,  physician,  nurse 
and  all  health  and  other  social  agencies.  The  wisest 
conduct  and  adjustment  in  ordinary  or  emergency  cir- 
cumstances requires  exceptional  understanding  and 
sound  judgment,  and  the  rural  teacher  should,  there- 
fore, be  unusually  efficient. 

HEALTH     TEACHING 

Effective  health  training  in  the  rural  schools  should 
aim  decisively  at  the  following  results : 

(a)  The  establishment  of  health  habits  and  incul- 

cation of  lasting  standards  of  wise  and  effi- 
cient living  in  pupils. 

(b)  The  extension  of  health  conduct  and  care  to 

the  school,  to  the  homes,  and  to  the  entire 
community. 

For  this  practical  and  important  school  task  the 
teacher  must  have  a  clear  understanding  and  confident 
command  of  the  application  of  facts  and  principles 
in  the  field  of  health.  If  this  instruction  is  to  be 
more  than  occasionally  successful  —  dependent  on  the 
individual  teacher,  who  happens  to  be  particularly 
interested  and  fortunately  situated  —  there  must  be 
helpful  and  wise  supervision  in  all  of  the  work  by  a 


20 

district  or  county  supervisor  well  qualified  to  guide 
the  health  teaching  with  the  rest  of  the  health  program. 
This  supervisor  may  be  the  health  officer,  the  regular 
school  supervisor  (if  trained  for  this  work)  or  a  wise 
and  efficient  school  nurse.  There  should  be  also  a 
state  supervisor  whose  duties  should  include  the  sys- 
tematic direction  of  the  health  teaching  in  the  rural 
schools. 

All  health  instruction  should  lead  promptly  to  the 
practical  training  of  the  pupils  in  personal  health 
habits  and  in  individual  and  group  efforts  for  the 
health  work  of  the  school,  the  home,  the  community, 
the  state,  the  nation  and  the  world  as  a  whole.  The 
modern  idea  of  pupil  organization  and  government 
may  be  used  to  good  advantage,  in  pupils'  boards  of 
health,  health  militias  and  other  forms  of  pupils' 
organizations.  The  Boy  Scout  idea,*  which  gives  such 
prominence  to  the  health  program,  may  be  utilized  to 
as  good  advantage  in  rural  as  in  city  schools  and  is 
being  so  employed  in  a  number  of  rural  districts. 

pupils'    health  organizations 

In  a  number  of  states  where  "Clean-Up"  and 
"School  Improvement"  days  have  been  observed,  the 
pupils  in  many  rural  school  districts  have  been 
organized  into  sanitary  squads  for  the  purpose  of 
maintaining  improved  conditions. 

The  nurses  in  Kent  County,  Michigan,  and  in  Grand 
Forks  and  La  Moure  Counties,  North  Dakota,  have 
''  organized  health  leagues  among  the  rural  school- 
children for  the  purpose  of  maintaining  sanitary  con- 
ditions in  the  schools  and  for  the  cultivation  of  per- 
sonal health  habits.  Similar  efforts  are  reported  from 
practically  all  the  other  states  having  county  nurses. 

WHOLESOME      PLAY     AND      RECREATION 

Rural  children  have  all  outdoors  to  play  in  and  yet, 
on  the  whole,  they  know  very  little  about  how  and 
what  to  play.  Many  rural  schools  have  not  enough 
space  for  an  adequate  playground,  which  is  not  a 
luxury  but  a  necessity  for  the  welfare  of  the  children. 
A  school  without  a  playground  is  an  educational 
deformity,  and  presents  a  gross  injustice  to  childhood, 

*  The  Eoy  Scout  organization  is  for  boys  of  from  12  to  16  years  old. 
The  Eoy   Pioneers  of  A.merica  is  for  boys  of  from  8  to   12  years  of  age. 


21 

Facilities  and  skilled  guidance  for  play  and  recrea- 
tion should  be  provided  at  the  rural  school  not  only 
for  the  pupils  in  the  school,  but  for  the  young  people 
in  the  community.  Such  provision  should  include 
not  only  athletic  games  and, sports,  school  and  folk 
dances,  but  also  dramatic  training  and  expression. 
Noteworthy  pioneer  effort  in  this  field  is  being  made 
very  successfully  by  Mr.  A.  G.  Arvold,  founder  of  the 
Little  Country  Theater,  in  Fargo,  N.  D.  Mr.  Arvold 
attempts  to  solve  through  organized  dramatics  the 
problem  of  the  desertion  of  the  country  for  the  city 
l3y  young  people  seeking  social  diversion.* 

The  national  welfare  demands  that  rural  life  should 
be  made  successfully  attractive  to  the  best  people. 
This  necessitates  generous  provision  for  the  social, 
esthetic,  emotional  and  artistic  requirements  of  young 
people  as  well  as  for  their  intellectual,  economic  and 
health  needs. 

COOPERATION    IN     HEALTH     WORK    OF     THE    SCHOOLS 

If  the  health  program  in  the  rural  schools  is  to  be 
successful,  it  must  enlist  the  cooperation  not  only  of 
all  individuals  logically  concerned  in  this  vital  aspect 
of  education,  but  also  of  all  organizations"  that  may  be 
naturally,  or  by  persuasion,  interested  in  the  welfare 
of  the  children.  The  granges,  medical  societies, 
w^omen's  clubs,  and  church  or  other  organizations  may 
find  abundant  work  to  do  if  the  complete  program  of 
health  is  attempted  with  any  thoroughness.  Several 
phases  of  the  health  program  may  require,  in  any  rural 
community,  the  support  of,  or  demonstration  by,  some 
volunteer  organization  before  school  boards  or  other 
governmental  agencies  are  convinced  of  the  necessity 
and  practicability  of  the  new  measures.  Every  com- 
munity in  country  as  well  as  in  city  vitally  needs  the 
help  of  some  volunteer  organization  of  unselfish  people 
whose  dominant  interest  is  the  health  and  welfare  of 
the  children. 

_*_The     Children's     Theater,     manufactured     by     the     Martin     Studios, 
Willimantic,  Mass.,  is  an  interesting  development  in  dramatic  art. 


22 


HEALTH    WORK    IN 

Activity 

Medical      inspection 
laws    in    23     states. 

Mandatory    laws. 

Permissive    laws. 


Medical      inspection 
practiced. 

Dental    inspection    by 
dentists. 


Dental    clinics. 


CITY    AND    RURAL    SCHOOLS    OF    THE 
UNITED    STATES 

For  City   Children  For  Country  Children 

Mandatory    for    cities 
only,    in    12    states. 

Apply   to    all    cities. 

Enforced     in     most 
cities. 

In    over   400   cities. 


In    69    cities. 


In    SO   cities. 


Clinics   for   eye,   nose,        In  cities  only. 
throat      and      other 
defects. 


Nurses. 

Open    air    classes. 


750   in    135    cities. 
In    cities    only. 


Mandatory  for  rural 
schools  in    7   states. 

In    7   states. 

In  6  of  the  13  states 
having     such     laws. 

In  13  states,  in  parts 
of    130    counties. 

Permitted  in  2  states, 
but  not  yet  pro- 
vided. 

In  one  rural  county, 
(St.  John's  County, 
Florida). 

None. 


12     in     20    rural    dis- 
tricts. 


Athletics  and  recrea- 
tion organized,  with 
appropriate  facili- 
ties and   equipment. 

Warm  lunches  in 
schools. 


Practically     all     cities 
and    large    towns. 


In    over    90    cities    in 
21    states. 


Little  provision   in 
rural    schools. 


In     a     few     scattered 
schools  in   9   states. 


23 


REFERENCES  ON  HEALTH  PROBLEMS  OF  RURAL  SCHOOLS 

Alabama's  Country  Schools  and  Their  Relation  io  Country  Life. 
Compiled  by  N.  R.  Baker,  State  Superintendent  of  Elementary  Rural 
Schools.  Department  of  Education  Bulletin  No.  33,  1913,  Montgomery 
Ala. 

Country  Life  and  the  Country  School.  A  study  of  the  Agencies  of 
Rural  Progress  and  of  the  Social  Relationship  of  the  School  to  the 
Country  Community.  By  Mabel  Carney.  Row,  Paterson  &  Co.,  New 
York,  1912. 

Educational  Hygiene.  (Contains  chapters  on  Rural  Schools.)  Edited 
by  Louis  W.  Rapeer.     Charles  Scribner's  Sons,  New  York,   1915. 

Hygienic  Conditions  in  Iowa  Schools.  University  Extension  Bulletin 
No.   11,  State  University  of  Iowa. 

Important  Features  in  Rural  School  Improvement,  and  other  topics 
relating  to  rural  schools,  in  Bulletins  of  the  United  States  Bureau  of 
Education,  Washington,  D.  C,  1913,  Nos.  3,  8,  23,  30,  42,  43,  44,  49, 
52;    1914,   Nos.    12,    17,   20,   25,   30,   31,   49;    1915,   Nos.   20,   21,   32,   48. 

Medical  Inspection  of  469,000  Schoolchildren  in  Pennsylvania. 
Health  Bulletin  No.  71,  July,  1915,  Harrisburg,  Pa.,  State  Department 
of   Health. 

Minimum  Health  Requirements  for  Rural  Schools.  Report  of  the 
Joint  Committee  on  Health  Problems  in  Education  of  the  National 
Council  of  the  National  Education  Association  and  of  the  Council  on 
Health  and  Public  Instruction  of  the  American  Medical  Association. 
Prepared  by  Thomas  D.  Wood. 

Plans  for  School  Improvement  in  Village  and  Rural  Communities. 
Issued   by    State   Department   of    Education,   Jefferson   City,   Mo.,    1914. 

Report  of  the  Ohio  State  School  Survey  Commission.  A  Study  of 
659   rural   village   schools.      1914. 

Rural  School  Efficiency.  Educational  Department  of  State  of  Maine. 
Reprinted  from  Maine  School  Report,  1907.  Sentinel  Publishing  Com- 
pany,   1909. 

Rural  School  Hygiene,  Medical  Inspection,  Etc.  Surveys  made  by 
United  States  Public  Health  Service  in  Virginia,  Florida,  West  Vir- 
ginia, Indiana,  Kentucky,  North  and  South  Carolina,  Tennessee.  Public 
Health  Reports,  Bulletins:  No.  23,  Vol.  29;  No.  6,  Vol.  29;  No.  11, 
Vol.  29;   No.   102,  Vol.   30. 

Rural  School  Nurses.  (1)  Report  of  Kent  Co.  (Mich.)  Nurse.  (2) 
The  Story  of  a  Red  Cross  Visiting  Nurse  on  Her-  Round  of  Visits,  etc. 
American  Red  Cross  Town  and  Country  Nursing  Service,  Washington, 

Social  and  Civic  Work  in  Country  Communities.  Report  of  a  sub- 
committee of  the  Committee  of  Fifteen  Appointed  by  the  State  Sitper- 
intendent  of  Schools  to  Investigate  Conditions  in  the  Rural  Schools  of 
Wisconsin.  Issued  by  C.  P.  Cary,  State  Superintendent,  Bulletin  No. 
18,   Madison,  Wis. 

Social  and  Economic  Surveys  in  Rural  Communities  in  Minnesota. 
The    LTniversity    of    Minnesota,    1913-1915. 

State  Legislation  Concerning  the  Examination  of  Schoolchildren's 
Eyes,   Ears,   Noses   and   Throats.      By   Dr.    Frank   Allport,   Chicago,   111. 


TEN  GOLDEN  RULES  OF  HEALTH 
FOR  SCHOOL  CHILDREN 

1.  Play  hard  and  fair — be  loyal  to  your  team  mates  and 
generous  to  your  opponents. 

2.  Eat  slowly.  Do  not  eat  between,  meals.  Chew  food 
thoroughly.  Never  drink  water  when  there  is  food  in  the 
mouth.    Drink  water  several  times  during  the  day. 

3.  Brush  your  teeth  at  least  once  a  day.  Rinse  your  mouth 
out  well  with  water  after  each  meal. 

4.  Be  sure  your  bowels  move  at  least  once  each  day. 

5.  Keep  clean — body,  clothes  and  mind.  Wash  your  hands 
always  before  eating.  Take  a  warm  bath  with  soap  once 
or  twice  a  week;  a  cool  sponge  (or  shower)  bath  each 
morning  before  breakfast  and  rub  your  body  to  a  glow 
with  a  rough  towel. 

6.  Try  to  keep  your  companions,  especially  young  children, 
away  from  those  who  have  contagious  diseases. 

7.  Use  your  handkerchief  to  cover  a  sneeze  or  cough  and 
try  to  avoid  coughing,  sneezing,  or  blowing  your  nose  in 
front  of  others. 

8.  Study  hard — and  in  study,  work,  or  play  do  your  best. 

9.  Sleep:  Get  as  many  hours  in  bed  each  night  as  this  table 
indicates  for  your  age.  Keep  windows  iii  bedroom  well 
open. 

Hours  of  Sleep  for  Different  Ages 


Age 

Hours  of  Sleep 

5  to  6 

13 

6  to  8 

12 

8  to  10 

1154 

10  to  12 

11 

12  to  14 

10^/4 

14  to  16 

10 

16  to  18 

9J4 

10.  Be  cheerful,  and  do  your  best  to  keep  your  school  and 
your  home  clean  and  attractive,  and  to  make  the  world  a 
better  place  to  live  in. 


TEN    ESSENTIALS    FOR     HEALTH     OP 

CHILDREN     IN    UURAL 

SCHOOLS 

I.  Daily  health  inspection  by  parent  and  teacher  with  the 
cooperation  of  school  nurses  and  doctors  for  detection  of 
early  signs  of  health  disorders,  to  control  and  minimize 
communicable  diseases. 

II.  General  health  examination  including  dental  examination, 
at  least  once  a  year,  for  discovery  of  physical  defects  and 
estimation  of  general  health  and  capacity  of  the  child. 

III.  Follow-up  health  work  with  provision  of  medical,  sur- 
gical, and  dental  care  for  correction  of  health  defects,  with 
service  of  school  or  district  nurse,  to  make  effective  the 
health  program  in  the  school. 

IV.  Warm  school  lunches  for  all  rural  school  children  to  be 
paid  for,  as  far  as  possible,  by  the  homes. 

V.  Sanitary  and  attractive  school  houses  and  surroundings 
which  are  essential  to  health  of  pupils  and  teachers. 

VI.  Efficiently  trained  teachers  qualified  to  do  their  full  share 
in  the  care  of  the  health  and  welfare  of  the  children. 

VII.  Practical  health  training  of  all  pupils  for  the  establish- 
ment of  health  habits  and  the  extension  of  health  conduct 
and  care  to  the  school,  to  the  homes,  and  to  the  community 
in  general. 

VIII.  Special  classes  and  schools  for  the  physically  and  men- 
tally defective  in  which  children  may  receive  the  care  and 
instruction  requisite  for  their  exceptional  needs. 

IX.  Generous  provision  for  wholesome  play  and  recreation  in 
school  and  community. 

X.  Organization  and  cooperation  of  the  home  and  the  school 
and  of  interested  people  and  societies  to  insure  to  all  chil- 
dren the  essentials  of  health  and  general  well-being. 


I 


